Financing Structuring Health Care Health Care Financing

Over the last several years, the role of insurance companies in providing different health care solutions has been increasingly brought to the forefront. This is because costs have been rising dramatically and the total number of uninsured is increasing. The combination of these factors has raised concerns that the many different consumers are being priced out of the system. To fully understand what is happening requires carefully examining how the industry operates. This will be accomplished by looking at: the three main types of insurance, the various categories, the types of managed care plans and the impact of managed care on Medicare / Medicaid. Together, these different elements will offer specific insights as to the underlying strengths and weaknesses of the U.S. health care system.

Identify and describe the three main types of health insurance in the U.S.

The three different kinds of health insurance include: health management organizations (HMOs), preferred provider organizations (PPO) and consumer direct health plans (CDHPs). An HMO will provide patients with access to a network of doctors. The way it works is the individual will sign up for a primary care physician. If there are specialist services or tests that...

A PPO is when patients will have a choice of primary care doctors and specialists within their network. CDHPs are designed to provide individuals with more choices of doctors inside the network for the insurance company. This is because, the person is contributing a certain amount of funds (on a yearly basis) that are designed to help pay for services they may need in advance As a result, they have greater flexibility in selecting doctors and hospitals. ("Types of Health Insurance," 2012)
Describe the three methods for categorizing health insurance in the U.S.

Three categories for health insurance include: indemnity, major medical and disability. Indemnity allows policyholders to choose doctors / health care providers and any kind of out of pocket expenses over select amounts of time. Major medical coverage is focused on protecting the individual from unforeseen accidents, injuries and catastrophic illnesses. Disability is when the insurance company will pay the policyholders compensation for not being able to work from: different medical conditions, their state of health and/or a specific injury. ("Health Insurance Coverage," 2012)

Identify the three types of managed care plans and provide the pros and cons of each for the health care provider, insurer, and patient.

The three types of managed care plans include: HMOs, PPOs and point of service plans (POS). A POS is when patients can see specialists and other doctors outside of the network. This is provided that they receive a referral from their primary care doctor. The benefits of an HMO include: they allow the health care providers and insurance companies…